DOI: http://dx.doi.org/10.18203/2349-2902.isj20181574

Renal traumas in childhood: a five years experience of tertiary care hospital in Turkey

Ahmet A. Tuncer, Hülya Gökbaş, Samet Deniz, Elif Ozkan, Hüsne B. Kocataş, Onur C. Kahya, Şeyma N. Demirci, Evrim Ozkaraca Boyacı, Didem Baskın Embleton, Salih Çetinkurşun

Abstract


Background: In this study, the experiences of kidney trauma of a third step hospital in a city at the junction of the road will be discussed with the current literature.

Methods: Pediatric trauma patients admitted to Afyon Kocatepe University Hospital between 1 January 2012 and 31 December 2017 were retrospectively examined. Thirty patients with renal injuries were included in the study. Patients with renal injury were examined in terms of age, gender, type of trauma, degree of renal injury, additional organ damage, treatment method, duration of hospitalization, cost and mortality. Statistical analysis was performed with the SPSS program. The p >0.05 was considered as significant.

Results: A total of 30 patients (m:23, f:7) were included in the study. The mean age of the patients was 12.10±5.70. The mean duration of hospitalization was 10.23±17.067 days. The reasons of kidney injury were determined as; traffic accident outside of the vehicle (n=9), fall (n=8), traffic accident inside the vehicle (n=6), bicycle-motorcycle accident (n=5), and firearm injury (n=2). Hematuria (n=8), grade 1 (n=12), grade 2 (n=2), grade 4 (n=5), and grade 5 (n=3) kidney injuries were detected in the patients. Isolated renal injuries were found in 7 patients. Additional organ injuries were found as lung injury (n=3), head injury (N=5), pelvic injury (n=5), spleen injury (n=8), spine injury (n=7), liver injury (n=7), intestinal injury (n=7), and extremity injury (n=7). The average cost was 4948.37 ± 10198.51 TL. One patient had nephrectomy and JJ catheter was placed to one patient due to the development of urinoma and hematoma. All other patients were treated conservatively. The cost and duration of hospitalization of patients with shock status at the time of admission to the hospital were statistically higher than those without shock status (p=0.001; p=0.025). Morbidity and cost of patients with high grades (grade 4 or 5) were higher than those with low grades (p=0.008 and p=0.027, respectively). There was no mortality except for a patient who underwent splenectomy and had concomitant brain parenchymal damage.

Conclusions: Conservative treatment of kidney injuries for children is effective and safe. Additional injuries, shock status and high-grade cause morbidity, mortality and cost increases.


Keywords


Trauma, Child, Renal, Crush, Cost, Conservative treatment

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References


Balcıoğlu ME, Boleken ME, Çevik M, Savaş M, Boyacı FN. Blunt renal trauma in children: A retrospective analysis of 41 cases. Ulus Travma Acil Cerr Derg. 2014;20:132-5.

Richards CR, Clark ME, Sutherland RS, Woo RK. Retrospective review of pediatric blunt renal trauma: a single institution's five year experience. Hawaii J Med Public Health. 2017;76:119-22.

Brown SL, Elder JS, Spirnak JP. Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study. J Urol. 1998;160:138-40.

Stylianos S, Hicks BA. Abdominal and renal trauma. In: Holcomb GW, Murphy JP, eds. Aschcraft’s Pediatric Surgery 5th ed. Philadelphia, PA: Saunders-Elsevier;2010:190-208.

LeeVan E, Zmora O, Cazzulino F, Burke RV, Zagory J, Upperman JS. Management of pediatric blunt renal trauma: A systematic review. J Trauma Acute Care Surg. 2016;80:519-28.

Overs C, Teklali Y, Boillot B, Poncet D, Rabattu PY, Robert Y, et al. Evaluation of the management of severe trauma kidney injury and long term renal function in children. J Trauma Acute Care Surg. 2018 Feb 17.

Lanchon C, Fiard G, Arnoux V, Descotes JL, Rambeaud JJ, Terrier N, et al. High grade blunt renal trauma: predictors of surgery and long-term outcomes of conservative management. A prospective single center study. J Urol. 2016;195:106-11.

Szmigielski W, Kumar R, Al Hilli S, Ismail M. Renal trauma imaging: Diagnosis and management. A pictorial review. Pol J Radiol. 2013;78:27-35.

Wessells H, Suh D, Porter JR, Rivara F, MacKenzie EJ, Jurkovich GJ, et al. Renal injury and operative management in the United States: results of a population-based study. J Trauma. 2003;54:423-30.

Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004;93:937-54.

Okur MH, Arslan S, Aydogdu B, Arslan MS, Goya C, Zeytun H, et al. Management of high-grade renal injury in children. Eur J Trauma Emerg Surg. 2017;43:99-104.

Malcolm JB, Derweesh IH, Mehrazin R, et al. Nonoperative management of blunt renal trauma: Is routine early follow-up imaging necessary? BMC Urol. 2008;8:11.

Genthon A, Wilcox SR. Crush syndrome: A case report and review of the literature. J Emerg Med. 2014;46:313-9.

Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: Hemorrhagic shock. Critical Care 2004;8:373-81.

Ceylan H, Gunsar C, Etensel B, Sencan A, Karaca I, Mir E. Blunt renal injuries in Turkish children: a review of 205 cases. Pediatr Surg Int. 2003;19:710-4.